By Tyler Coyle
8:00 AM EST, November 3, 2013
The Food and Drug Administration's 1983 blanket ban on blood donation from men who have sex with men (MSM) is outdated, discriminatory and medically unjustifiable.
Millions of Americans are denied the opportunity to donate life-saving blood products based solely on their sexual orientation — instead of on their individual risk profiles. This antiquated policy stigmatizes gay men and unnecessarily depletes medical resources.
The FDA's argument for banning MSM donors is that the prevalence and incidence of HIV and hepatitis cases remain higher among MSM than their proportional representation in our population. So, if a man has had a single same-sex encounter any time since 1977, he is deemed ineligible.
By contrast, the typical deferral time for a blood donor who visits a prostitute or gets a tattoo is 12 months. The inconsistent — and implicitly offensive — underpinnings of this policy are shameful.
There is a roughly 1-in-2-million chance that the donor screening test fails to identify an infected sample. The screening protocols — in place since 1999 — are excellent. Virtually all cases of HIV transmission through blood product transfusions have involved donors in the "window" of undetectable infection rather than a defect of the test. By shelving the blood for about a week, labs can determine with greater than 99.99 percent accuracy whether the donated blood is infected.
Technology from 2013 screens our blood, but policy from 1983 governs our eligibility.
Rather than a blanket ban on any one group, we should be using every donor's individual medical risk profile as guidance for allowing or disallowing their donation of blood products. Factors like intravenous drug use, recent tattoos and risky sexual behavior should be the criteria by which we judge fitness for donation, not one's sexual orientation. Such a policy will enfranchise more donors — meaning more donated blood, which our nation desperately needs — while maintaining the high standard of scrutiny with which we screen our collective blood resources for viruses like HIV and hepatitis.
It is time to modernize. The FDA is currently in the process of reviewing its long standing ban on blood donations from MSM. Australia, Japan, South Africa, New Zealand and the UK have all recently revised their comparable bans. The American Medical Association, American Association of Blood Banks and Red Cross have all called for reform. Senator Elizabeth Warren, a Massachusetts Democrat, and 80 of her congressional colleagues have recently submitted a letter to Department of Health and Human Services Secretary Kathleen Sebelius urging modification of the policy, proposing that each donor's medical risk profile — not one's sexual orientation — be the benchmark for fitness of blood donation.
Some policy decisions are difficult — but this isn't one of them. Make the right choice, FDA.
Dr. Tyler Coyle is a preventive medicine resident at the University of Maryland, Baltimore.
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